A study of biochemical markers of reperfusion early after thrombolysis for acute myocardial infarction. The PERM Study Group. Prospective Evaluation of Reperfusion Markers
| Autor: | T, Laperche, P G, Steg, M, Dehoux, J, Benessiano, G, Grollier, E, Aliot, J M, Mossard, P, Aubry, D, Coisne, M, Hanssen |
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| Rok vydání: | 1995 |
| Předmět: |
Male
Myoglobin Myocardial Infarction Myocardial Reperfusion Middle Aged Coronary Angiography Coronary Vessels Sensitivity and Specificity Troponin Cohort Studies Isoenzymes Fibrinolytic Agents ROC Curve Troponin T Predictive Value of Tests Case-Control Studies Humans Female Thrombolytic Therapy Creatine Kinase Biomarkers Vascular Patency |
| Zdroj: | Circulation. 92(8) |
| ISSN: | 0009-7322 |
| Popis: | In acute myocardial infarction (AMI), early noninvasive identification of patients with occluded infarct-related arteries (IRAs) after thrombolysis has important prognostic and therapeutic implications. The aims of this study were to evaluate biochemical methods for the early diagnosis of patency after thrombolysis prospectively and to establish the optimal diagnostic criteria retrospectively.In 97 patients with AMI treated with thrombolytic agentsor = 6 hours after the onset of symptoms, myoglobin, troponin T, creatine kinase, the MB isoenzyme and MM isoforms of creatine kinase were measured just before thrombolysis began and 90 minutes later. IRA patency was assessed by means of 90-minute coronary angiography. For each marker, compared with the expected sensitivity and specificity based on published thresholds for the diagnosis of patency, the observed values were consistently lower but were markedly improved in a subset of patients treated3 hours after the onset of symptoms. With receiver-operator characteristic curve analysis of the slopes of increase and relative increases in each marker over 90 minutes, the best diagnostic performance was achieved by use of the relative increase in myoglobin, troponin T, and MM3/MM1 creatine kinase isoforms in patients treated3 hours after onset (areas under the curve of 0.84, 0.83, and 0.85, respectively).Effective early noninvasive diagnosis of patency after thrombolysis is possible in patients treated3 hours after symptom onset by use of criteria derived from the relative increase over 90 minutes in plasma markers, particularly myoglobin, troponin T, and MM3/MM1 creatine kinase isoforms. The diagnostic performance of the relative increase in myoglobin appears to be less susceptible to small changes in the diagnostic threshold value. |
| Databáze: | OpenAIRE |
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